Healthcare Provider Details

I. General information

NPI: 1720215205
Provider Name (Legal Business Name): ELLEN DELL MORELAND ACNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 HIGHWAY 70 E
GLENWOOD AR
71943-8801
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-4801
  • Fax: 870-356-5470
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberS002285
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: